DKA
Diabetic Ketoacidosis. Yup. That's what we've dealt with at our house the past two days, including an all-expenses-not-necessarily-paid overnight stay at our fabulous local hospital.
Brittany has handled her diabetes remarkably well over the years. We've had a few hiccups along the way, but never anything too serious. Until yesterday. I've got to back up a little bit.
Not too long ago, Brittany decided she was sick and tired of giving herself insulin shots every day and opted to get an insulin pump. An insulin pump is kind of like wearing one's pancreas on the outside of the body instead of the inside. Of course, one must set the parameters and input the proper data in order for the pump to do it's job correctly, so it still requires vigilance and a little work but it does eliminate a fair amount of hassle for the diabetic. Most diabetics also find their blood sugars are better controlled with a pump, as long it's used correctly.
So anyway, this is Brittany's pump, except her's is black.
There is a tiny catheter that Brittany injects into herself (her preferential site is her arm) that has tubing that connects to the pump. The insulin continuously runs through the tubing and into Brittany, almost like what a real pancreas does for the rest of us. When Britt wants to eat something, she tests her blood sugar, enters that number into the pump and tells the pump how many grams of carbohydrate she is going to consume and the pump works it's magic and figures and delivers the appropriate amount of insulin.
On Monday night before bed, Brittany changed her pump site (the site - the spot where the catheter is inserted - is supposed to be changed approximately every three days) but unbeknownst to her, the catheter did not insert itself into Brittany's arm, it somehow managed to tuck itself into the sticky tab that holds it in place. So all of sudden Brittany was getting no insulin at all. She awoke early Tuesday morning nauseated and started throwing up. The vomiting continued throughout the morning without letting up. Britt was becoming dehydrated and was incredibly thirsty so she kept trying to drink, but without fail, it would come back up within a few minutes. I admit I was a little slow to clue into what was going on. We had gone out to dinner for family night and I just thought Britt had eaten something bad.
About mid-morning I realized the cause of the nausea and vomiting was due to Brittany's blood sugar being too high so we started bolusing her insulin. Her blood sugar continued to climb despite our efforts and Britt began to exhibit other signs of ketoacidosis in addition to the throwing up and high blood sugars. Her pulse was racing (210 beats per minute) even though she was just lying on the couch. Her face was so pale, and she was becoming extremely dehydrated. Her breathing was becoming very rapid and labored. She was dizzy and lacked the strength to walk very far or even sit up straight.
I called the Endocrinologist at about 1:00 and got to talk to what must be one of the stupidest MA's to ever hold a job. I'll spare you the details of that conversation, but by the time I hung up the phone, it was decided that I'd just take Britt to the ER. At this point Brittany's blood sugar was 492. Normal for her is less than 150. Normal for a non-diabetic is less than 120. I realized that the insulin from the pump wasn't cutting it (although I didn't know why) so I gave Brittany a shot of insulin before we left for the hospital.
We arrived at the ER a little before 2:00 and when we walked into the reception area I told the receptionist that Brittany had diabetic ketoacidosis. She didn't know what that was and asked me how to spell it. It told her to just put "DKA". Another receptionist overheard me and immediately got a tech to bring a wheel chair out for Brittany and they took her back right away, we didn't have to wait at all. Brittany was assessed, IV's were started, labs drawn, and her blood sugar was checked. By this time her blood sugar was 591. The insulin I gave her at home hadn't helped. Britt's strength was pretty much gone by this time and she was so thirsty and kept asking for water, which the medical staff would not allow. She had become so dehydrated that the nurse had a hard time getting the IV in and the respiratory therapist struggled a bit to get blood from her radial artery for a blood gas.
After his initial assessment, the PA in the ER agreed that Brittany was in DKA. Another glucose check told us her blood sugar was now over 600. (The hospital's meter could only read up to 600 and after that it just says "High" and that's what the result was.) Diabetic ketoacidosis occurs when the blood sugar is too high and there isn't enough insulin to move the glucose into the cells. Insulin acts as a key that unlocks the cells and allows the glucose to enter the cell to be used as energy. When the body lacks the proper amount of insulin, the cells begin to starve because even though there may be enough glucose in the blood stream, it can't get into the cells without the insulin. When this happens, the body begins to break down fat to be used as energy (this is how the Atkin's diet works). Ketones are produced when fat is broken down. Ketones are toxic and cause the blood to become acidic. If left untreated, DKA can be fatal. Sidenote: Wikipedia states that "before the introduction of insulin therapy in the 1920's it [DKA] was almost universally fatal."
Treatment for DKA is IV fluids and insulin. Blood sugars are closely monitored as well as electrolytes. Heart rate is also closely watched because electrolytes that are out of whack will cause irregularities in the heart rate, which can lead to more problems.
The ER staff wanted to rule out any possibility that the spike in blood sugars was a result of some underlying bacterial infection. Brittany had had a mild cough a few days earlier so a chest x-ray was done to rule out possible pneumonia. It was negative, as was the urine culture and the strep test.
Brittany was admitted to the pediatric unit for the night. While she was in the ER, Britt kept asking for water to drink. At first the staff said no but they finally gave in to her. Dr. Clarke (her endocrinologist) wrote orders for ice chips only once she was admitted to peds. Of course, Brittany was mad about that because she was still really thirsty. Even though she was extremely dehydrated and needed fluids, too much too fast can cause cerebral edema in kids (brain swelling) with DKA. I didn't know this (and apparently the ER staff didn't either) or I wouldn't have let her have anything to drink while she was in the ER. We may have dodged a bullet here, because that kid GUZZLED a ton of water.
Brittany had a relatively good night, probably as good of a night as one can have in the hospital. Her blood sugar was checked every two hours and labs were drawn every four. I spent the night there with her and she was discharged this morning. She is absolutely exhausted today but other than that she feels good.
I had Maya with me when I took Brittany to the ER. Luckily, my mom was able to come pick her up and head to our house for when Brooklyn and Damon got home from school. Brent was working in Ogden but was scheduled to finish earlier than usual. In the end, he was able to reschedule his last patient and get to the hospital to see Brittany. She wanted a priesthood blessing so we called my brother Eddie to come help. Brent had taken today, Thursday, and Friday off work. He was summoned for jury duty so he had to make an appearance this morning. My mom was able to come back to our house to get Brooky and Damon out the door for the bus and to take care of Maya. Brent was dismissed from jury duty, the plaintiff turned out to be one of his patients, so he has a couple days off now.
I feel very responsible for this whole episode and I'm sorry Brittany had to endure something so rotten. The insulin pump appeared to be working just fine and it never occurred to me that the catheter might not be in place. I should have been thinking harder and I should have thought to pull it out and insert a new one. I guess I'm still learning, as I had no experience with insulin pumps prior to a few weeks ago. But still, my child had to suffer because I had tunnel vision.
As I sat there in the emergency room helplessly watching my daughter suffer through this ordeal, I could not help but be amazed at her strength and bravery. She did not even flinch when the IV's were inserted and the blood was drawn. She didn't hardly seem to notice the blood gas. She never once complained about lab people wanting her blood every few hours through the night and she never really even seemed to need me to offer comfort through any of this. I don't think that can be said for too many kids. Brittany is a trooper. She is so strong and is such a good example of enduring trials. I know she doesn't particularly enjoy the challenges she's been given but she faces them head on and does the best she can. I love you, Britt. You are my hero.
Brittany has handled her diabetes remarkably well over the years. We've had a few hiccups along the way, but never anything too serious. Until yesterday. I've got to back up a little bit.
Not too long ago, Brittany decided she was sick and tired of giving herself insulin shots every day and opted to get an insulin pump. An insulin pump is kind of like wearing one's pancreas on the outside of the body instead of the inside. Of course, one must set the parameters and input the proper data in order for the pump to do it's job correctly, so it still requires vigilance and a little work but it does eliminate a fair amount of hassle for the diabetic. Most diabetics also find their blood sugars are better controlled with a pump, as long it's used correctly.
So anyway, this is Brittany's pump, except her's is black.
There is a tiny catheter that Brittany injects into herself (her preferential site is her arm) that has tubing that connects to the pump. The insulin continuously runs through the tubing and into Brittany, almost like what a real pancreas does for the rest of us. When Britt wants to eat something, she tests her blood sugar, enters that number into the pump and tells the pump how many grams of carbohydrate she is going to consume and the pump works it's magic and figures and delivers the appropriate amount of insulin.
On Monday night before bed, Brittany changed her pump site (the site - the spot where the catheter is inserted - is supposed to be changed approximately every three days) but unbeknownst to her, the catheter did not insert itself into Brittany's arm, it somehow managed to tuck itself into the sticky tab that holds it in place. So all of sudden Brittany was getting no insulin at all. She awoke early Tuesday morning nauseated and started throwing up. The vomiting continued throughout the morning without letting up. Britt was becoming dehydrated and was incredibly thirsty so she kept trying to drink, but without fail, it would come back up within a few minutes. I admit I was a little slow to clue into what was going on. We had gone out to dinner for family night and I just thought Britt had eaten something bad.
About mid-morning I realized the cause of the nausea and vomiting was due to Brittany's blood sugar being too high so we started bolusing her insulin. Her blood sugar continued to climb despite our efforts and Britt began to exhibit other signs of ketoacidosis in addition to the throwing up and high blood sugars. Her pulse was racing (210 beats per minute) even though she was just lying on the couch. Her face was so pale, and she was becoming extremely dehydrated. Her breathing was becoming very rapid and labored. She was dizzy and lacked the strength to walk very far or even sit up straight.
I called the Endocrinologist at about 1:00 and got to talk to what must be one of the stupidest MA's to ever hold a job. I'll spare you the details of that conversation, but by the time I hung up the phone, it was decided that I'd just take Britt to the ER. At this point Brittany's blood sugar was 492. Normal for her is less than 150. Normal for a non-diabetic is less than 120. I realized that the insulin from the pump wasn't cutting it (although I didn't know why) so I gave Brittany a shot of insulin before we left for the hospital.
We arrived at the ER a little before 2:00 and when we walked into the reception area I told the receptionist that Brittany had diabetic ketoacidosis. She didn't know what that was and asked me how to spell it. It told her to just put "DKA". Another receptionist overheard me and immediately got a tech to bring a wheel chair out for Brittany and they took her back right away, we didn't have to wait at all. Brittany was assessed, IV's were started, labs drawn, and her blood sugar was checked. By this time her blood sugar was 591. The insulin I gave her at home hadn't helped. Britt's strength was pretty much gone by this time and she was so thirsty and kept asking for water, which the medical staff would not allow. She had become so dehydrated that the nurse had a hard time getting the IV in and the respiratory therapist struggled a bit to get blood from her radial artery for a blood gas.
After his initial assessment, the PA in the ER agreed that Brittany was in DKA. Another glucose check told us her blood sugar was now over 600. (The hospital's meter could only read up to 600 and after that it just says "High" and that's what the result was.) Diabetic ketoacidosis occurs when the blood sugar is too high and there isn't enough insulin to move the glucose into the cells. Insulin acts as a key that unlocks the cells and allows the glucose to enter the cell to be used as energy. When the body lacks the proper amount of insulin, the cells begin to starve because even though there may be enough glucose in the blood stream, it can't get into the cells without the insulin. When this happens, the body begins to break down fat to be used as energy (this is how the Atkin's diet works). Ketones are produced when fat is broken down. Ketones are toxic and cause the blood to become acidic. If left untreated, DKA can be fatal. Sidenote: Wikipedia states that "before the introduction of insulin therapy in the 1920's it [DKA] was almost universally fatal."
Treatment for DKA is IV fluids and insulin. Blood sugars are closely monitored as well as electrolytes. Heart rate is also closely watched because electrolytes that are out of whack will cause irregularities in the heart rate, which can lead to more problems.
The ER staff wanted to rule out any possibility that the spike in blood sugars was a result of some underlying bacterial infection. Brittany had had a mild cough a few days earlier so a chest x-ray was done to rule out possible pneumonia. It was negative, as was the urine culture and the strep test.
Brittany was admitted to the pediatric unit for the night. While she was in the ER, Britt kept asking for water to drink. At first the staff said no but they finally gave in to her. Dr. Clarke (her endocrinologist) wrote orders for ice chips only once she was admitted to peds. Of course, Brittany was mad about that because she was still really thirsty. Even though she was extremely dehydrated and needed fluids, too much too fast can cause cerebral edema in kids (brain swelling) with DKA. I didn't know this (and apparently the ER staff didn't either) or I wouldn't have let her have anything to drink while she was in the ER. We may have dodged a bullet here, because that kid GUZZLED a ton of water.
Brittany had a relatively good night, probably as good of a night as one can have in the hospital. Her blood sugar was checked every two hours and labs were drawn every four. I spent the night there with her and she was discharged this morning. She is absolutely exhausted today but other than that she feels good.
I had Maya with me when I took Brittany to the ER. Luckily, my mom was able to come pick her up and head to our house for when Brooklyn and Damon got home from school. Brent was working in Ogden but was scheduled to finish earlier than usual. In the end, he was able to reschedule his last patient and get to the hospital to see Brittany. She wanted a priesthood blessing so we called my brother Eddie to come help. Brent had taken today, Thursday, and Friday off work. He was summoned for jury duty so he had to make an appearance this morning. My mom was able to come back to our house to get Brooky and Damon out the door for the bus and to take care of Maya. Brent was dismissed from jury duty, the plaintiff turned out to be one of his patients, so he has a couple days off now.
I feel very responsible for this whole episode and I'm sorry Brittany had to endure something so rotten. The insulin pump appeared to be working just fine and it never occurred to me that the catheter might not be in place. I should have been thinking harder and I should have thought to pull it out and insert a new one. I guess I'm still learning, as I had no experience with insulin pumps prior to a few weeks ago. But still, my child had to suffer because I had tunnel vision.
As I sat there in the emergency room helplessly watching my daughter suffer through this ordeal, I could not help but be amazed at her strength and bravery. She did not even flinch when the IV's were inserted and the blood was drawn. She didn't hardly seem to notice the blood gas. She never once complained about lab people wanting her blood every few hours through the night and she never really even seemed to need me to offer comfort through any of this. I don't think that can be said for too many kids. Brittany is a trooper. She is so strong and is such a good example of enduring trials. I know she doesn't particularly enjoy the challenges she's been given but she faces them head on and does the best she can. I love you, Britt. You are my hero.
Comments
Get well soon Brittany!!!!
Recover quickly Brittany!